Breast-Dedicated Radionuclide Imaging Systems and Applications

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 14, 2023:

Nuclear Medicine Technology: 3.25
Image Production: 0.25
Instrumentation: 0.25
Procedures: 3.00
Endocrine and Oncology Procedures: 1.50
Other Imaging Procedures: 1.50

Outline

• Part I: Breast-Dedicated Radionuclide Imaging Systems
  1. Introduction
  2. BD Positron Emission Mammography (PEM) and PET Camera Designs
     1. System Configuration
     2. Detector Design Issues
  3. BD Single-Photon Camera Designs
     1. System Configuration
     2. Detector Design Issues
  4. Tracer Development for BD Radionuclide Imaging
  5. Clinical Translation of BD Cameras
  6. Conclusion

• Part 2: Nuclear Breast Imaging: Clinical Results and Future Directions
  1. Introduction
  2. The Evidence
  3. Extent of Disease
  4. Screening
  5. Standardized Interpretive Criteria and Quantification
  6. Tumor Subtypes
  7. Future
  8. Summary

Objectives

Upon completion of this course, students will:

1. know the roles that non-invasive molecular imaging can play in breast cancer evaluation
2. be familiar with the current various breast-dedicated PET imaging detector configurations
3. understand the disadvantages of translatable and rotatable BD PET imaging detector heads in comparison with stationary BD PET imaging systems
4. know the typical patient positioning for fully tomographic BD PET systems
5. be familiar with the differences in C-shaped ring and O-shaped ring BD PET detector systems
6. understand the advantages of dual curved panels in PEM imaging systems
7. be familiar with the methods to better image for potential lesions at the chest wall on BD PET systems
8. understand the cause and effect of parallax blurring in BD PET systems
9. be familiar with the current BD PET systems, their geometry and crystal types
10. be familiar with the methods for creating crystal arrays that provide depth-dependent scintillation light behavior
11. understand the effects of crystal size on BD PET systems that use discrete crystal elements
12. know the effects of high crystal-packing fraction and stopping power in BD PET systems
13. be familiar with the advantages of single-panel and dual-panel BSGI systems
14. know the current crystal alternative to NaI for single-photon gamma camera systems
15. be familiar with the collimator and spatial resolution specifications for the current BD single-photon gamma camera systems
16. understand the major factors in scanner design affecting single-photon gamma camera systems
17. know the collimator that can be utilized on BD single-photon gamma cameras to better image of the chest wall
18. know the methods by which ^99mTc Sestamibi targets cancer cells for imaging
19. know why some tumors in the central breast are visible on only one of the two mammographic views in PEM systems
20. know the ways in which BD PET systems have great potential in breast cancer treatment and evaluation
21. be familiar with the clinical translation information of BSGI/MBI cameras
22. know the advantages of combining MBI with mammography screening
23. be familiar with the advantages of biopsy-compatible BD radionuclide imaging cameras
24. know the radiopharmaceutical information and basics of lead shielding for the ^99mTc-sestamibi and ¹⁸F-FDG imaging agents
25. be familiar with the available options in dedicated breast gamma-camera imaging
26. understand why mammographic technologists should be included in the patient positioning for nuclear breast imaging, at least for a minimum number of cases
27. be familiar with the typical imaging delay time after injection, time for each acquisition, and total minimum time for a total nuclear breast imaging exam of both breasts
28. know what additional views might be necessary to fully include all the breast tissue
29. know the first use case type of the ^99mTc-sestamibi radiotracer
30. know the reason why approximately 1cm of tissue at the extreme posterior of the breast is not well evaluated on PEM
31. know the type of breast PET systems that should improve visualization of posterior tissues
32. understand how to improve lesion-to-background uptake in ¹⁸F-FDG-based imaging
33. know patient preparation and post-injection instructions for both ^99mTc-sestamibi and ¹⁸F-FDG-based breast imaging
34. be familiar with the principles of dose limitation in medical imaging and radiation effective dose amounts for nuclear breast imaging
35. know the organ that receives the highest radiation dose for ¹⁸F-FDG-based imaging studies
36. be familiar with MRI’s ability to demonstrate additional occult disease in both the ipsilateral and contralateral breast tissue after a newly diagnosed cancer
37. know the reason why percutaneous biopsy of additional suspicious findings is important after BSGI before converting a patient to mastectomy
38. know how PEM and MRI compare for assessing disease extent in ipsilateral and contralateral breast tissue
39. know the missing receptors of which triple-negative breast cancers consist
40. be familiar with the reasons why neither ^99mTc-sestamibi nor ¹⁸F-FDG imaging is reliable at identifying metastatic axillary adenopathy
41. be familiar with the reasons for recommending annual breast cancer screening with MRI
42. be familiar with the BIRADS terminology and format used for mammography, ultrasound, MRI, and now nuclear breast imaging assessments
43. be familiar with situations in which background uptake of ^99mTc-sestamibi can be greater than normal
44. be familiar with the various types of breast cancer subtypes that can be imaged well with ¹⁸F-FDG
45. be familiar with the various radiotracers that are not currently approved for clinical use for nuclear breast imaging in the US